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APPLICATION FOR CONSTRUCTAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVEREI?, WA 98201 • (025) 257-88I0 <br />L7 DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL IJ PLUMBING L7 SIGN <br />PROJECT ADDRESS: _ 215 —1 • d <br />IrN•MI YM Yl011ti a" 71• frgNr <br />Allry•i LI UnMYMAn MAN AMIPLSS OM1 ", <br />Y `31Cy l i na NUFvrs - See A Too we SK V LT-H�1 O,5I di <br />I�rb1114 CON/NLrp11 Mre.c- bt CIII !R AMM SILII IKfNV 1 <br />IRCN.MC4 ffMI11GCIW Yµ Abd{51 an Im `VI %WF LCEMR• <br />Alnl[p COY1nK,1011 Y4 Allplt) GM1 7M pNpR FIAn ICFNIF• - <br />c➢NrAAc 1 /Y•1'I a Y1011• <br />HEATING SYSTEM: ❑ OAS ❑ ELECTRIC ❑ <br />MxM1p YIM• ANII SDISR MOIAOF MYOlHO <br />CONI•CI rIK)D.AIQ h10NF MO <br />r <br />( > > L-10il - 4 <br />•M1q)FO W M F•1 O•RI <br />Iran MxwnrIOMMaa ER ILOIIN t[LOnw mtcx <br />AIpM M <br />_— <br />mllrf <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7I/1S TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />ODIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TINE STATE <br />CONTRACTORS LAW IA 27 RCW AND 2N 200 WAC <br />A <br />"ASCII, In in MIn1N n <br />CpISIgICTION 101MIFMIIrn 11KY1[Sb RISH44M m <br />UOMAIME n.11 <br />DIV m SIT IcIMAEw <br />PLUMBING <br />MECHANICAL - <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILE <br />FVC _ ANNOU) UNITS <br />Z- <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PIMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK E DISP <br />CLOTHES DRYERS <br />OISIIWASHER <br />RANGE HOOD <br />1 <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />I <br />a METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT WOOD BURNING) <br />I <br />FLOOR DRAIN <br />I <br />GAS FIREPLACE <br />GAS RANGE <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPWG <br />EXHAUST FAN <br />_ <br />SUBTOTAL f 1 <br />SUB TOTAL E <br />_ <br />PERMIT 11 <br />PERMIT f <br />TOTAL FEE 61 <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />I MINI Vll1�� <br />R2 <br />MAP SI��f <br />SKI[6f1�A� <br />JF <br />n.IICIAMMIN/YR <br />�7G� <br />rtl <br />Mf1•'IMO <br />�rw ilwr <br />R�l <br />wltwl �IAYLn" <br />IMI AqA <br />s 950 <br />rALANI uR <br />)4"s Dw <br />FEES <br />VALUATION <br />- <br />FFE <br />A,1,~ <br />wrMNNbu <br />_ <br />— <br />_ <br />� <br />� pPAt 111M0 <br />SYI OI RObII <br />yU1�T•a. N•ry.�nl. <br />IMI .r'a1FM ROV <br />�a.� _ <br />IIy ^ A /_ <br />AW NFU➢ <br />-Ly <br />Irr�ln•xnu•n <br />uvwNl <br />.ODIIOM4n WlHf. <br />--- <br />MAi1M <br />OINK <br />� <br />gI1FIM <br />C E ETT LOCAL <br />LOCAL BALAL ER <br />L3 TAX CODE IS 7105 <br />SIAII 9,04LnA1 MAC WAnF—f <br />nwcKOAtA <br />- <br />— <br />TOTAL <br />-j- <br />